A midwife and "Birthing From Within" mentor, I am passionate about informed decision making and helping moms and partners birth in awareness. My blog chronicles my journey from cesarean to vaginal birth after cesarean and my quest for information to help families have EMPOWERING births.

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June 03, 2011

Thaddeus Arrives Face First

If my 37th year had a theme, it would be the year God reminded me at every turn that I am not in control; the birth of Thaddeus was no exception. Thankfully I had gotten the message loud and clear and so while I had a pretty clear picture of his birth (middle of the night, in the birth pool, easing baby out and catching him/her myself, surrounded by family with my fellow student midwife/future midwifery partner quietly in the corner and supervising midwife nearby) as I neared 40 weeks I also knew that birth, like life, cannot be controlled. And so I made sure to double make the bed, placing my extra polk a dot shower curtain for protection underneath the top sheet, just in case I had the baby on the bed.

The first surprise was that I did not go into hard labor after the kids were neatly tucked into bed, as I did with my second and third babies, but in the early evening. I hoped for a Sunday birth. It was the last chance my baby had to meet my sister as a newborn. My sis was coming up Monday morning in order to say goodbye before flying back to New Mexico. She was in Williamsburg on Sunday celebrating my Dad’s 75th birthday. Since it was HOT and I had a baby that kept trying to slide into a posterior position (swimming helps encourage an anterior position) I decided to spend Sunday afternoon at the pool with the kids. At the pool, I noticed that my warm-up contractions (I had been having strong warm up contractions from about 34 weeks on) were 8-10 minutes a part, but this was nothing new for this pregnancy. Swimming, I palpated my relaxed belly and confirmed what I suspected, baby was definitely facing posterior (also known as sunny side up). After the swim, it became slightly uncomfortable to walk through contractions and, though this wasn’t new either, it was time to go home. We gathered the kids, and climbed in the car. In the car I had a contraction that was very uncomfortable in my sitting position and I thought, hmm, tonight is the night. It was 5pm and I texted my midwives, to let them know that if this labor was anything like my last labors, baby was coming tonight.

We arrived home at about 5:15pm. Dinner wasn’t made, the kids were starving and tired from sun and swimming and the birth pool needed filling. Before we could get started, Matt announced he needed to go to the hardware store to buy an extra connection in order to fill up the birth pool. Things were chaotic and at 5:50pm, realizing that Matt could not get everything done by himself and realizing that I needed to make space for active labor to start, I called Mimi and asked if she could come over to help Matt. She came over shortly after 6, and together Matt and Mimi were able to feed the kids and get the birth pool set up while I moved into active labor. I am not sure when that move came, let’s say 6:15pm. By 6:35pm, when Liz called to see if she should head up to Baltimore and drop off her partner or come straight to my house, I was no longer interested in talking to anyone and had shut myself in the basement bathroom. Thankfully Mimi took the call, updated Liz on the situation and they decided Liz should come right away.

Liz arrived at 7pm and mentioned she wanted to start setting up so I asked her to call Mairi. Mairi, who lives in Takoma Park as well, was quickly on her way. At some point things became more intense and it was time to turn on the CD of gospel music I had prepared for the birth. I headed upstairs, where I would remain for the birth. The music deepened my connection to the spiritual nature of birth and opened my awareness of the unfolding miracle. I am again and again awed by the spiritual power of birth and felt my body flood with the intense energy of the Spirit. I needed all the help I could get as this was my hardest labor, probably because it moved so quickly. In barely over an hour I went from thinking I might be in early labor to having intense ctx 3 minutes a part.

As soon as the tub filled up I climbed in (7:45pm) and sang and labored, grateful for the water’s soothing warmth. Sometime after 8pm I checked myself and felt a very bulging bag of waters and a very soft and stretchy cervix. It is hard to check yourself when you have short fingers so I have no idea how far dilated I was nor did I care. Sometime later I felt the need for a position change and climbed out of the water thinking I might go downstairs and sit on the toilet. Standing by the side of the tub, my water broke and I stood frozen for minutes watching the spreading pool of fluid, unsure of what to do next. I climbed back in the tub and noticed that my uterus was pushing; I watched it rise up and move down with incredible force, encouraging baby to move on out. I felt baby wiggling and squirming and kicking inside me. The thing is, while my body was pushing, something didn’t feel right and I was resisting. I didn’t have trouble pushing with Nettie or Fen and even enjoyed second stage… Since I had checked myself only a little over 30 minutes ago and felt cervix, I thought, I must not be fully dilated and that is why this feels so different from pushing Fen and Nettie out. I called Liz to check me but realized “I can check myself.” I slipped in a finger to feel a hard palate, then a mouth sucking on my finger! Imagine my surprise!

I asked Liz to check me to confirm a face presentation and she thought she felt a nose but couldn't be 100% sure (Is anyone 100% sure when they feel a face? Our fingers expect to feel heads...). I called “Mairi!” and Liz and I agreed I would get out of the tub so that Mairi could check me on the bed. (Mairi had been just downstairs listening and holding the space, ready to help if needed, as I wanted as few people upstairs as possible until the birth. For much of the labor it was me with Liz quietly sitting nearby). I asked to hear to heart tones (my request had been no heart tones unless necessary knowing that if mom knows baby is moving well, baby is ok) because I was concerned by a face presentation and I felt a change in baby's pattern of movement. I thought baby was posterior and remembered something that was not at all good about the combination of posterior and face (in labor, your brain doesn’t work so well, after birth, I remembered that it is a posterior chin that is not good, not a posterior baby, a baby with a posterior chin should not be born vaginally while a posterior baby with an anterior chin can). The pain was too much to bear for a vaginal exam on my back so I asked Mairi to check me on all fours, half leaning on the bed.

Heart tones at some point dropped. While I didn’t have a watch, as a student midwife, I know the sound of poor heart tones. I looked at Liz and Mairi, unsure of what to do next. This is why we have midwives. When you are in labor land, things can get very fuzzy. A woman in labor shouldn’t have to think and I needed direction. Mairi said “I think you need to push your baby out now, it would help if you got into McRoberts to flex the head,” and my body moved quickly into McRoberts where I started pushing with all my might. (While I started pushing, my husband quickly ran downstairs to get the kids.) I think I had about one contraction the entire time I was pushing. The rest of the time I was bearing down, thinking of the thunk, thunk, I heard on the Doppler and knowing it was time for baby to come out. I moved Thaddeus swiftly under my pubic bone and heart tones came back up and he started to pink up. I took a breath and continued to push him out, giving an extra strong push to birth the shoulders. I didn’t catch my baby as planned. The effort required to push my baby out without contractions while lying on my back required one-pointed focus. I paused a second to touch his emerging face but I wasn’t able to focus on how my pushing was progressing and when I would need to catch him. At 9:06pm, a short 16 minutes after I first felt him sucking on my finger inside me, Thaddeus was born. He was caught with lots of love and by my request, no gloves, by my future midwifery partner, my loving preceptor midwife standing by and surrounded by the love of my life and our three amazing kids. My friend Mimi, who was such a help to Matt during the birth, was an incredible help to me during pushing and immediately after the birth.

Pushing Thaddeus out was HARD and having a circle of support while doing it made it easier. Thaddeus arrived, face first, with only a bit of bruising around the eyes. Mimi, a gifted cranio-sacral therapist helped Thaddeus release the intensity of the experience caused by his unusual position and helped me relax my sacrum so that I could eventually sink back into pillows with Thaddeus resting on my chest. While the birth of Thaddeus was certainly a surprise, I think the biggest surprise came at the end of the newborn exam. Thaddeus weighed in at 8 pounds 9 ounces, a full 1.3 pounds bigger then my biggest baby! Not to mention that the presenting diameter of his face was not small at all. And I thought I made small babies!

There is much more to the story, this is only a small snap shot. There were friends downstairs that I was not aware of, silent helpers, there to be with the kids, to hand off from one friend to the other as needed, so that Matt was always free to be with me if called, my unseen village supporting me. But I have gone on long enough. Much love to you Thaddeus from your mom, dad and three siblings!!!!

*A note on face first babies, Anne Frye (Holistic Midwifery Volume II, pg. 121) notes that they are unusual, averaging about 1 in every 545 births.

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